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~ -~ <br />'EHMfTTEE NAME/ADDRESSpkfude Fariliry NmndLoca~ion ijDifferenq <br />NAME OVAL POLLUTANT DISCHARGE EIJMINA710N $Y.STEM pJPDES) <br />~ Form AppfOVed. Q <br />*• (- <br />:~fIR'~ ~ <br />f DISCHARGE MONITORING REPORT fNR <br />M <br />; OMB No. 2040-0004 ' <br />~ <br />ADDRESS! r , ~ <br />ir;k,. THOMPSOR <br />('SL'~?I( 81 <br />rz'sl PT- <br />~ "1 I D R Approval expires05-31-98 ' <br /> PtII{ES .rn nT c n7- (clS°R ~~~ . <br />27f,; COItPtSS D°.Ifl6~ $(tjYr 101 PERMIT NUMBER •~ DISCHACiGEr+uweER <br /> <br />~ F _ <br /> <br />:. <br />'" PI"Kv <br />L;F9tiJJ JOM"'i'" <br />FACILITY ~ "-;0'$1505 '~~ MONITORING'PERIO'~ ~ `,"T <br />rtl`'~ ;; Tk'°T!.G F01' 0~~74 <br />LOCATION <br />~ <br />~ DAY <br />YEAA~ MO DAY YEAR' MO <br /> <br />CA' <br />+ <br />"F'DgI' <br />A T'f <br />) <br />' <br />~ <br />-~ 623 <br />FROM 9 `TO 9 A 7 <br />h'Y~ !!'? n),rH _ <br />~ kGpp, ~~~~[[//i -'•''•-" <br />' <br />h : . <br />~ F. , ., 1 <br />' J <br />I; , ~,; l,' ; ; r; ~ (zo-z z-z3) [2azsl as-zv1 rze-zvl (30.70 NOTE: Read Instru f~mpleting this fortn- <br />ctions befote <br />I <br />ARAMETER (3 Card Ony) QUANTITY OR LOADI (<Cerd Ony) QUANTITY OR CONCENTRATION ~ NO. FREOUENO SAMPLE <br /> (46x3) 5a-sr ' 3s<5) (46.53) (5o-e T) EX OF TYPE <br />(32-3n: <br /> <br />' AVERAG •. ,MAXIMUM MINIMUM AVERAGE <br /> <br />- MAXIMUM <br />ANALYSIS <br />UNITS <br />rsz-sT/ (sa-sa 69-70 <br /> P. ''FtC .: ;. 7^A/ :^ LE 4;:~:~kR# 4##It## #{:#i7;~.t r.QI~SrtOSt ~ '3) <br /> <br /> ~ <br /> :.: Cis...; vT5 B°L04' REOUF9 ,;,:: `~ d'k-`•;r :~•r;,~ ^c-wT si ~ ; <br /> SAMPLE <br />uvecim~.. ~.,~ <br />- <br />i <br />~ SAMPLE <br />L' ;~ <br />SAMPLE <br />ERMIT `'~`i'- <br />`'' , IilF1EMENT .ai~iBYt ~,!' -- <br />SAMPLE <br />SAMPLE <br />SAMPLE <br />ywy~r,~ i } x i '{, y~ = t <br />~. `~il~'~ ,~ n~~ <br /> <br /> NA10 LE PRINCIPAL EXECUTIVE OFFICER I CERTIFY UNDER PENALTY OF L <br />AM FAMILIAR WITH THE INFORM AW THAT I HAVE PERSONALLY ExAMINED AND <br />AT <br />BMIT <br />H TELEPHONE DATE I <br /> .. <br /> <br />I <br />INQUIRY OF THOSE INDIVIDUAL ON SU <br />TED <br />EREIN; AND BASED ON MY <br />S IMMEDIATELY RESPONSIBLE FOR OBTAINING <br /> 1~C •% <br />~ ~ ~ ~ S <br />f <br />• THE INFORMATION, I BELIEV <br />ACCURAT <br />AND <br />MPLET E THE SUBMITTED INFORMATION IS TRUE, <br />I <br />/ <br />~ <br /> ~ E <br />CO <br />E. <br />PENALTIES FOR SUBMITTING AM AWARE THAT THERE ARE 9GNIFICANr <br />FALSE INFORMATON <br />INCLUDING TH ~_ ~ <br /> <br />~( , ~._~ }r <br />POSSIBILffV OF FINE AND IMPRI , <br />E <br />SONMENT. SEE 10 U.S.C. § 1001 AND 33 U.S.C. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />'a <br />7 / <br />9Y'I <br />i. <br />7 <br /> TYPED OR PRINTED <br />p <br />meximuml~ ns~mn~nt ol0e~txAee~ n e~i mfM antd butle li,rea up lu 510,000 uM n <br />yeys.) <br />OFFICER OR AUTHORIZED AGENT <br />NUMBER ~ <br />YEAR <br />MO <br />LtAI(S/ <br />COMMENTS AND EXPLANATION OF ANY VIOLATIONS (Reference ell erlachmen4 here) <br />:,e~ f.ll.°~ F;1? Tc'"„ PRCC~;UUE~. RFT HFSJLTS OF L?1T9ALT'P ~F^.7YATIONS 4~. ~°.'.FP"!'"N, CRONTR RBP 90DUCTTON <br />i;t,>31YATIJIiS Ai `TOn~~ITI`. A.PT LGa`:ST ', F.FFL Af i1ftICH $TATISTTT'ALLT 57;47° DIFF °ETW*_'BN TEST 6 COtITROL <br />P -'~onnm 3320.7 (OB='95)° Pr'ewous e i dns rhdy ~ ~yspd. ' n r t (REPLACES~E'PA t~`OHM ~~D~WHII:~AfiAY NOT BE US 5 ~ ~ °j ~~H L. N N GE~ <br />t OOOIr/ 902 11-20'33 ~ <br /> „ <br />